NPI | 1902143225 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL-11653) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207190) |
225100000X Physical Therapist (Licence: CO PTL.0011653) | |
Enumeration Date | 2013-01-07 |
Last Update Date | 2020-12-23 |